Hammer Toe: causes, symptoms and treatments

Updated 12/18/2023
In this video, we talk about the causes of hammertoe and how to correct them.

What's a hammer toe?

A hammertoe occurs when the middle joint of the toe develops an abnormal bend and becomes flexed or bent downward. This is due to a muscle imbalance around the toe joints and usually happens in the second, third, and fourth toes.

 

This imbalance causes the toe to bend at one or more joints, eventually pushing the middle of the toe upward into a claw-like position.

 

Unfortunately, a hammertoe causes pain and won’t get better without intervention. The sooner it is treated, the better the outcome and the shorter the recovery.

What causes a hammer toe?

Although hammer toes are principally hereditary, they can develop over time as the toe’s tendon is abnormally stretched and pulled. This foot health issue can happen due to a few different risk factors, including:

 

  • Trauma or injury to the foot or toe
  • Abnormally high arches
  • Flat feet
  • Weak calf muscles
  • Wearing shoes that are too tight, too pointy, or lack arch support.
  • Children wearing shoes they have outgrown.
  • Strain caused by a bunion as the second toe elevates and becomes bent to make room for the shifting big toe.
  • Diseases that affect the bones, muscles, tendons, and ligaments. Arthritis, diabetes, neuromuscular disorders, and stroke can all increase the likelihood of hammertoe.

 

 

 

Flexible hammertoe vs. rigid hammertoe: what’s the difference?

In its early stages, a hammertoe is flexible, meaning the joint can still move and might be able to be straightened manually. At this stage, the tendons and muscles are still supple

 

A flexible hammertoe can be uncomfortable and may cause pain, but because the toe can still move, there are more treatment options available, often involving less invasive measures like physical therapy, custom orthotics, or splints.

 

As the condition progresses, the toe can become rigid. In this stage, the tendons have tightened, and the joint becomes immobile. The toe cannot be straightened manually. 

 

Rigid hammertoe often causes more pain and discomfort. Friction between the hammertoe and shoes may also lead to more complications like sores, calluses, or corns. Treatment for rigid hammertoe is more limited and often requires surgery to correct the deformity.

 

Early intervention in a flexible hammertoe can prevent progression to a rigid hammertoe. Therefore, it's important to seek medical advice when symptoms first appear.

 

What are the symptoms of a hammer toe?

The primary symptoms of hammertoe are problems with walking and other foot problems, such as blisters, calluses, and sores. There is also pain caused by constant friction over the top of the toe’s main joint.

 

It may be difficult to fit into some shoes due to the extra space required for the deformed toe. In many cases, there will be pain on the ball of the foot over the metatarsals along with callus formation. This is due to the toes not functioning properly and failing to properly touch the ground during the gait cycle. The ball of the foot then takes the brunt of the ground forces, which causes chronic pain.

 

How is a hammer toe diagnosed?

The first step is a physical evaluation of the toe by our podiatrists. We also take X-rays to determine the extent of the contracture. An examination of the entire foot allows us to identify the root cause of your hammertoe.

 

What are non-invasive treatment options for hammer toes?

When caught early, we have more conservative options to choose from. The goal of early treatment is to accommodate the hammertoe, provide pain relief, and keep the deformity from progressing.

 

Some options include:

 

Better footwear

Choose comfortable, proper-fitting shoes with a wider toe box that are a half-inch longer than your longest toe. Shoes made with Lycra are often a good choice because the material stretches generously around the irregular toe structure. Avoid pointy or narrow shoes and if you wear high heels, keep the heels at two inches or less.

 

Toe braces and taping

Some toe braces and taping techniques can take some pressure off the toes while you’re walking.

 

Callus control

We can professionally shave down the calluses on the toe and the ball of the foot to reduce some pain and pressure. However, they will return due to the pressure from the hammertoe.

 

Custom orthotics

Custom molded shoe inserts can redistribute the forces through the tendons that control the toe, lessening the pain and extent of the deformity.

 

Foot rollers

Our doctor can provide you with a therapeutic foot roller that you can use at home to stretch and massage the tendons of your foot, relieving some tension and pain.

 

Anti-inflammatory medication and ice packs 

These treatments can help alleviate swelling and reduce pain. 

 

Surgical treatment options for a hammer toe

Hammertoe Representation

For more severe hammertoe, we have to turn to surgical correction to bring the toe into position and increase its function. Correction of the hammer toes is a simple outpatient surgery with limited downtime.

 

Fusing the toe: PEEK implant system

The best option is to fuse the affected toe. This limits the need for future surgery and the risk of the hammertoe returning.

 

The PEEK hammertoe implant system is a next-generation implant that was designed with the help of our physicians. The implant is made of a material that is similar to bone, and not visible on an X-ray. This allows the surgeon to visualize the fusion site on an X-ray, without the shadows of titanium that occur with traditional implants.

 

What further differentiates the PEEK implant from other products is that it can easily be removed and has great fixation strength. It also allows for the toe to be aligned in a straight position or at a 10-degree angle for a more natural look.

 

OSSIOfiber® all-natural implant

University Foot & Ankle Institute is proud to offer a revolutionary non-metal fixation option for hammertoe surgery called OSSIOfiber®. OSSIOfiber is a bio-degradable polymer mixed with a mineral fiber that slowly grows into the human bone, reinforcing the bone at the healing site. 

 

It is eventually eliminated and replaced by the body’s own bone through natural cellular turnover. So, the material not only 

 

Removing the hammer toe deformity

In the most extreme cases, the removal of a small area of bone in the deformity area will decrease pain and limit the need for a surgical waiting period that is found with fusions. Although the toe is not as stable as with a fusion, in certain cases, an arthroplasty is the best option.

 

See our patient's before and after picture gallery of hammertoes surgeries here.

What are the benefits of hammertoe surgery?

After surgery, patients can look forward to getting back to the activities they love. Pain and discomfort are corrected and there will no longer be any pain when walking or hiking because the toe joints will no longer feel pressure or rub against the inside of shoes.

 

This leads to improved health which, in turn, allows our patients to lead active lives. They will no longer feel self-conscious about taking their shoes off at the beach and can feel comfortable walking barefoot.

 

Hammer toe surgery recovery

The procedure to correct a hammer toe lasts approximately one hour. Following the surgery, patients are in a walking boot for six weeks to protect the foot while it heals. Then, you’ll have about two more weeks of swelling decline but will be able to wear shoes. 

 

Why choose University Foot and Ankle Institute for hammer toe treatment?

Dr. Bob Baravarian, DPM, and our team of podiatrists have revolutionized hammer toe correction over the last two decades. We pride ourselves on offering the most advanced diagnostic technology and treatment options available.

 

UFAI surgeons and sports medicine experts offer their revolutionary approach to the surgical treatment for hammertoes and related foot deformities. We use a screw or absorbable pin for rapid healing and early weight-bearing. There is often no need for a pin to stick out of the toe post-surgery, which may be a source of infection and rigid fixation. Our goal is to get you back on your feet in the least invasive, quickest way possible.

 

University Foot and Ankle Institute podiatry clinics are conveniently located throughout Southern California and the Los Angeles area. Our foot doctors are available at locations in or near Santa Monica, Beverly Hills, West Los Angeles, El Segundo, Northridge, Downtown Los Angeles, Westlake Village, Santa Barbara, and Valencia.

 

 

Hammer Toe and Hammer Toe Surgery FAQs

 

What are mallet toe and claw toe?

Similar to hammertoe, mallet and claw toe are deformities that cause the toe to bend downward. Instead of the middle toe joint, mallet toe affects the joint closest to your toenail, and claw toe affects the joint nearest to the ball of your foot. Mallet toe and claw toe have many of the same causes, symptoms, and treatment methods as hammertoe.

 

Are hammertoes the same as corns?

No, but corns often form alongside hammertoe. Corns look like tough bumps of skin that form over a foot or toe joint. Corns are essentially layers of skin that have grown in response to the joint rubbing on the inside of your shoe.

 

How is hammertoe treated?

 Mild and moderate cases of hammertoe are usually treated conservatively with orthotic inserts and well-fitting footwear that allow for comfortable movement and promote healing.

 

How does hammertoe surgery affect performance in sports, especially football and running?

Hammertoe correction surgery actually helps performance in sports, especially with grip and foot strength.

 

Can hammertoe be treated with surgery?

Severe hammertoes may be treated with surgery. Surgery can reduce pain and improve the appearance and functionality of the toes. Hammertoe correction surgery is an outpatient procedure with very little downtime.

 

What can I expect during my recovery from hammertoe surgery?

Most patients are able to walk with the help of crutches and a special boot provided by their doctor. Pain and swelling are normal for about a week following surgery. Your doctor can prescribe you medication to manage the pain. Get plenty of rest and keep the foot elevated while sitting or lying down

After hammer toe surgery:

  • 2-3 weeks: Stitches may be removed.
  • 4-6 weeks: Any surgical pins that were used may be removed.
  • 6 weeks: Average recovery time. Some people may return to their normal routine as soon as 2 weeks, while others may take up to 3 months. Generally, the pinky toe is the quickest to recover, while the second toe takes the longest.

  

Can a hammertoe come back after surgery?

Some cases of hammertoe do relapse following surgical correction. Depending on the type of surgery and your aftercare routine, the deformity may return. If your toe begins curling again and you are experiencing discomfort, visit your foot and ankle specialist.



 Have any hammer toe questions we should add to our FAQ's? Please let us know by clicking here.

 

 

 

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